- Battelle Memorial Institute (Columbus, OH)
- …operations and high-quality patient care. **Responsibilities** + Assist with the management and treatment of outpatient behavioral health activities + Under the ... supervision of a licensed psychiatrist, social worker, psychiatric nurse or psychologist, responsible for providing a wide range of behavioral health interventions… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse within the Clinical Access Grievance Team utilizes ... care management and utilization management skills...are available as needed. The Clinical Access Grievance Team Nurse uses clinical knowledge, communication skills, and independent critical… more
- Humana (Columbus, OH)
- …Work hours will be an 8.5-hour shift between 7:00am - 5:00pm CST. The Utilization Management Nurse 2 uses knowledge, communication, and independent critical ... Qualifications** + Associate's Degree or higher + Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary...a team **Preferred Qualifications** + BSN + Knowledge of Utilization Management + Previous Medicare and Medicaid… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Columbus, OH)
- …**Must have active current and unrestricted RN licensure in state of residence** ** Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area** **Managed Care experience preferred, especially Utilization Management ** **preference for those residing in EST zones**… more
- CenterWell (Columbus, OH)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CenterWell (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...volume and fast paced environment + Previous experience in utilization management + Education: BSN or bachelor's… more
- CVS Health (Columbus, OH)
- …experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal ... clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Conduct clinical reviews for adult… more
- Sharecare (Columbus, OH)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- Molina Healthcare (Columbus, OH)
- …and cost-effective member care. **Job Duties** + Performs Behavioral Health utilization management reviews for inpatient, outpatient, and intermediate-level ... and/or Nurse Practitioner, ideally in managed care, behavioral health, or utilization management . + Demonstrated experience in the application of medical… more
- CVS Health (Columbus, OH)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Pediatrics, **Oncology** or Specialty Pharmacy. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or … more
- Molina Healthcare (Columbus, OH)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- Molina Healthcare (Columbus, OH)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) ... modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/appeals. + Provides… more
- Elevance Health (Columbus, OH)
- …**Field Nurse - Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care needs by ... **Field Nurse - Nurse Case Manager II**...and ensuring smooth execution. + Assists with development of utilization /care management policies and procedures, chairs and… more
- Trinity Health (Powell, OH)
- …demeanor in difficult situations. . Knowledge of the functional operations of utilization management , discharge planning, business offices, and third party ... **Employment Type:** Full time **Shift:** **Description:** **Family Nurse Practitioner, Full-Time** **Position Purpose:** The APRN - Nurse Practitioner provides… more
- Elevance Health (Columbus, OH)
- …required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Highmark Health (Columbus, OH)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
